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Beneficial effects of coronary revascularization in patients with ischaemic left ventricular dysfunction with and

Alessia Gimelli1, José Antonio Marin Neto, Claudio Marcassa

  • 1Nuclear Cardiology, CNR Institute of Clinical Physiology, Via Moruzzi 1, 56124 Pisa, Italy. gimelli@ifc.cnr.it

Interactive Cardiovascular and Thoracic Surgery
|August 3, 2007
PubMed

Insights

Coronary revascularization benefits patients with ischaemic heart failure and viable myocardium, even without chest pain. This therapy improves outcomes for individuals with left ventricular dysfunction, enhancing survival rates.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Ischaemic congestive heart failure (CHF) management is established for patients with angina.
  • The role of revascularization in CHF patients without chest pain is less understood.

Purpose of the Study:

  • To compare the benefits of coronary revascularization in patients with ischaemic heart failure, stratified by the presence or absence of chest pain.
  • To evaluate the impact of viable myocardium on outcomes after revascularization.

Main Methods:

  • A prospective study of 180 patients with New York Heart Association (NYHA) class III-IV CHF and low ejection fraction (28±9%).
  • Patients were divided into two groups: Group A (97 patients) with chest pain (angina) and Group B (83 patients) without angina.
  • Myocardial viability was assessed using Thallium-201 uptake.
  • Follow-up was conducted for 3 years.

Main Results:

  • Intraoperative mortality was comparable between groups (5% in Group A, 7% in Group B).
  • Viable myocardium was a strong predictor of improved heart failure symptoms and wall motion abnormalities at 6 months.
  • At 3 years, survival rates were similar for revascularized patients with viable myocardium in both groups (89% in Group A vs. 87% in Group B).

Conclusions:

  • Coronary revascularization may benefit patients with ischaemic left ventricular dysfunction and viable myocardium, irrespective of anginal symptoms.
  • The presence of viable myocardium is crucial for positive outcomes following revascularization in heart failure patients.
  • Revascularization should be considered for heart failure patients with preserved myocardial viability, even in the absence of chest pain.

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